[Account of a case in which the subclavian artery was tied successfully / by Robert Liston, ].

  • Liston, Robert, 1794-1847.
Date:
[1820?]
Catalogue details

Licence: Public Domain Mark

Credit: [Account of a case in which the subclavian artery was tied successfully / by Robert Liston, ]. Source: Wellcome Collection.

    6/8 (page 6)
    with any other, of whatever fashion. The difficulty appeared to be, not in bringing up the point of the needle so as to catch the loop of the ligature, but in getting it beyond the ves¬ sel. This is readily accomplished with the instrument I used, and which is delineated in the accompanying plate. From its construction at the point, as soon as this can be seen or felt, the ligature is immediately laid hold of by the hook or forceps. Having passed the needle, armed with a strong round silk liga¬ ture, under the vessel with but little difficulty, I soon exposed the point, by rubbing the cellular substance betwixt it and my finger, and, with a small hook laying hold of the loop, with¬ drew the instrument. I then, by tightening the two ends of the cord, and pressing with my finger betwixt them, so as to command the pulsation, assured myself that the ligature was properly placed. From the very great depth and contracted nature of the wound, it was impossible to draw the knot with the fingers, and accordingly it became necessary to have re¬ course to some mechanical means. The purpose was fully an¬ swered by the very simple contrivance of my friend Mr Na¬ smyth, who obligingly assisted me at the operation. The in¬ strument and mode of using it, is shewn in the plate. We had previously tried it on the dead body, and ascertained its effica¬ cy. The ligature was thus easily secured by a reef knot, with the effect of immediately arresting the pulsation in the tu¬ mour and wrist. The patient bore the operation with the greatest courage *, with all the preparations, removal, and re¬ placement in bed, it occupied about half an hour. The wound was brought together by three stitches, and covered with dry lint. The constitutional derangement consequent to the operation was but slight. The pulse, in any part of the body, never was much above 100; nor did the action of the heart or large ves¬ sels seem at all disturbed. The patient was instantly relieved from pain, so as to sleep with but a very small dose of laudan¬ um (one-third of what he was in the habit of taking without ef¬ fect), and the heat of the arm was never at all lessened. The pulsation in the tumour returned on the day after the opera¬ tion, shewing the great activity of the anastomosing vessels, but disappeared again entirely in two days. On the fourth day, I dressed the wound, and found it adhering completely ; but a little matter oozed along the ligature, with some small clots of blood. Next morning, betwixt twelve and one o’clock, 1 was sent for on account of violent haemorrhage. On my arrival, l found him a good deal exhausted, and surrounded with blood, apparently venous. On opening the wound, the stream was